Surgical treatment of acquired left ventricular pseudoaneurysms

Background. We present a review of our experience with acquired pseudoaneur ysms of the left ventricle in order to establish the risk of surgical repai r. Methods. Ten patients operated upon for a left ventricular pseudoaneurysm i n our clinic between 1984 and 1999 were reviewed. The pseudoaneurysm, a com plication of myocardial infarction (four acute and three chronic) or previo us cardiac surgery (three chronic), was resected in all patients and the ve ntricular wall defect closed with direct sutures (five cases) or a patch (f ive cases). Coronary artery bypass graft was performed in 6 patients. Results. Three patients died (postoperative mortality 30%) after repair of an acute postinfarction (2 patients) or a chronic postsurgical (1 patient) pseudoaneurysm. Three patients died during follow-up (median 4 years) of a carcinological (2 patients) or cardiac (1 patient) cause. Two years after r epair, 5 patients were in New York Heart Association class I or II, and 1 p atient was in class III. Conclusions. Repair of left ventricular pseudoaneurysms can be performed wi th acceptable results, although mortality is significant in acute myocardia l infarction and redo operations. Propensity for fatal rupture, however, is higher than the surgical risk in acute pseudoaneurysms or in large or expa nding chronic ones and warrants surgical repair. The best approach to small asymptomatic chronic pseudoaneurysm is unsettled. (C) 2000 by The Society of Thoracic Surgeons.